Forage de données de bases administratives en santé
|Advisor:||Gagné, Christian; Reinharz, Daniel|
|Abstract:||Current health systems are increasingly equipped with data collection and storage systems. Therefore, a huge amount of data is stored in medical databases. Databases, designed for administrative or billing purposes, are fed with new data whenever the patient uses the healthcare system. This specificity makes these databases a rich source of information and extremely interesting. These databases can unveil the constraints of reality, capturing elements from a great variety of real medical care situations. So, they could allow the conception and modeling the medical treatment process. However, despite the obvious interest of these administrative databases, they are still underexploited by researchers. In this thesis, we propose a new approach of the mining for administrative data to detect patterns from patient care trajectories. Firstly, we have proposed an algorithm able to cluster complex objects that represent medical services. These objects are characterized by a mixture of numerical, categorical and multivalued categorical variables. We thus propose to extract one projection space for each multivalued variable and to modify the computation of the distance between the objects to consider these projections. Secondly, a two-step mixture model is proposed to cluster these objects. This model uses the Gaussian distribution for the numerical variables, multinomial for the categorical variables and the hidden Markov models (HMM) for the multivalued variables. Finally, we obtain two algorithms able to cluster complex objects characterized by a mixture of variables. Once this stage is reached, an approach for the discovery of patterns of care trajectories is set up. This approach involves the followed steps: 1. preprocessing that allows the building and generation of medical services sets. Thus, three sets of medical services are obtained: one for hospital stays, one for consultations and one for visits. 2. modeling of treatment processes as a succession of labels of medical services. These complex processes require a sophisticated method of clustering. Thus, we propose a clustering algorithm based on the HMM. 3. creating an approach of visualization and analysis of the trajectory patterns to mine the discovered models. All these steps produce the knowledge discovery process from medical administrative databases. We apply this approach to databases for elderly patients over 65 years old who live in the province of Quebec and are suffering from heart failure. The data are extracted from the three databases: the MSSS MED-ÉCHO database, the RAMQ bank and the database containing death certificate data. The obtained results clearly demonstrated the effectiveness of our approach by detecting special patterns that can help healthcare administrators to better manage health treatments.|
|Document Type:||Thèse de doctorat|
|Open Access Date:||24 April 2018|
|Collection:||Thèses et mémoires|
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